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RespiratoryNov 23, 2020

Prominent physio fears 'medical model' could dominate in new 'long Covid' units

The physiotherapist who led the allied health professions' response at London’s NHS Nightingale Hospital earlier this year has warned that government plans for ‘long Covid’ units must include a multidisciplinary dimension.

Rachael Moses was appointed assistant director for rehabilitation and therapies at the Royal Brompton and Harefield NHS Trust in London after the Nightingale units were wound down across the country. 

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Rachael Moses says allied health professionals can play a crucial role in long Covid

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Asked about the plans to create long Covid units that were announced on 15 November, Ms Moses told PhysioUpdate: ‘The long Covid clinics seem to be designed as a “one stop” service where you attend and get a range of diagnostic tests and are then signposted to other existing services.

‘The one-stop clinic model works well in other specialist areas, but these are generally run by specialist multidisciplinary teams (MDTs).’

In such a model, Ms Moses said patients have access to, and are assessed by, doctors, allied health professionals (AHPs) and nurses – all often working at a very advanced or consultant levels. 

If the long Covid clinics are run by a MDT then they could be a great resource for patients. However, if they are only run by doctors then you lose the holistic aspect of the MDT clinic as it becomes a very medical model

‘You are assessed based on your presenting symptoms and then intervention or therapy based on findings as part of an MDT. 

Ms Moses is a council member at the Chartered Society of Physiotherapy and president elect at the British Thoracic Society.

She noted: ‘If the long Covid clinics are run by a MDT then they could be a great resource for patients. However, if they are only run by doctors then you lose the holistic aspect of the MDT clinic as it becomes a very medical model, and we know a lot of the long Covid symptoms require therapy input.'

What is known already about people with long Covid?

‘We know that most people who contract Covid-19 will either be asymptomatic or have a mild illness with symptoms lasting less than two weeks. 

‘We also know that a number of people who have a relatively mild form of the illness go on to experience a “crash and burn” situation and develop long-term disabling symptoms. 

‘Long Covid seems to be able to affect anyone – with no strong correlation between the severity of the initial illness and long-Covid symptoms. For that reason, it is difficult to predict the demand for specialist clinics.'  

Physiotherapy can be 'extremely effective' in treating patients with post-viral symptoms

Ms Moses pointed out that the symptoms of long Covid include fatigue, breathlessness, headaches, concentration problems (or ‘brain fog’), heart palpitations, chest discomfort and ‘pins and needles’ type pain in the limbs.

'These are all common symptoms that we see in post-viral patients, for which physiotherapy can be extremely effective in terms of assessment and advice,’ she said, 

PhysioUpdate asked Rachael Moses about staffing implications and any gaps in services, amid claims that they are already hard-pressed

‘In an ideal world we would have existing rehabilitation pathways these patients could enter but as community rehabilitation is grossly underfunded this is not the case. 

‘As it stands if a patient needed onward referral for community therapy of any description, the service gaps are so significant that it’s unlikely most areas would be able to meet these patients’ needs. 

‘There are some excellent examples of stroke and frailty pathways as well as pulmonary rehabilitation, but they are often disease or condition specific.   

‘Covid-19 has highlighted the significant funding gap in community rehabilitation, and we can only hope that this will change in 2021.’

See also the news item on this site titled ‘Warning issued over staffing pressures on new long Covid units’

Author: Ian A McMillan
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